Team AckoDec 14, 2021
Optimum utilisation of employee healthcare plans is a win-win situation for both the employers and the employees.
A productive employer-offered Group Medical Cover (GMC) features a host of wellness benefits along with a seamless insurance experience. This encourages the employees to maintain a healthy lifestyle, stay adequately insured, and avail of required services on time. Consequently, all this usually translates into reduced costs, better performance, and enhanced goodwill for the employers.
However, this win-win situation might not materialise if the employees do not utilise the GMC.
Read ahead to know:
top reasons why employees might be underutilizing the GMC
what employers can do to improve GMC utilization
Let’s get started!
Here’s why employees might find it difficult to utilise their employer-offered healthcare plans.
This is the most common reason for the underutilisation of employee healthcare benefits.
Employees may not be entirely aware of the particulars of a policy, such as the sum insured or the illnesses covered.
At times, when the amount spent on medical expenses is relatively low, employees may not register a claim to avoid the cumbersome and confusing claim process.
Coverage, in this context, includes the sum insured, types of illnesses eligible for claims under the policy, and the inclusion of other ancillary or incidental expenses associated with healthcare.
Inadequate GMC coverage might lead employees towards undermining its usefulness as they will have to incur expenses from their pocket.
If the sum insured is low, employees might not register claims, anticipating the need to utilise the benefit when they incur higher medical expenses.
Organisations might offer a GMC that is restricted only to the employees.
It may not seem directly beneficial to the organisations to include their employees’ immediate family members in the GMC. However, there could be employees who shoulder the medical and financial responsibilities of their dependent family members.
Excluding immediate family members from the policy can result in employees looking for individual or family floater health plans to cover their family.
Employees might not prefer to share information about their medical conditions with their employers due to the fear of being judged.
Irrespective of the nature and type of illness, some employees might wish to keep their medical history private.
They may avoid registering claims against certain illnesses as the ensuing paperwork might involve co-workers in the process, exposing their privacy to those colleagues.
In most cases, the top management chooses the insurer, the coverage, and other aspects pertaining to GMC.
Often, the inputs from the employees, the actual beneficiaries of the policy, might not be sought.
Due to such a non-participative decision-making process, the attractiveness of a GMC can reduce significantly.
The lack of flexibility in a GMC can result in underutilisation by its primary beneficiaries, the employees.
Individual policies tend to be far more flexible than the GMC with respect to coverage and services.
Even employees who consider health insurance a top priority might prefer individual health insurance policies over the GMC due to the prior’s personalisation features.
The following measures can be undertaken to ensure employees make optimal use of the employer-offered insurance cover.
While most organisations provide information about all the employee benefits during induction training, such information can be overwhelming!
Organise regular training sessions to facilitate greater recall of GMC features and benefits.
Representatives from the insurance company could conduct webinars explaining features of the policy in detail, and address employee queries.
Emails/newsletters highlighting the policy’s details can be circulated at regular intervals..
Through a participative process, organisations should consider increasing the GMC coverage. To do so, companies must consider the following.
Enhancing the sum insured.
Increasing the number of people insured.
Covering more illnesses.
Additionally, group healthcare plans can be made as flexible and tailor-made as individual insurance policies by providing optional riders with the basic GMC. Riders are additional covers applied to the basic coverage of an insurance policy.
The following riders are examples of how organisations can increase the cover offered by their healthcare plans.
Riders to increase the coverage amount via top-up plans.
Riders to include ancillary healthcare expenses not covered in a basic plan, such as the cost of consumables, daily cash allowance, COVID-19 cover, doctor consultations, etc.
Riders to cover critical illnesses.
Riders can be availed of by the employees voluntarily by paying an additional premium. With such detailed coverage, employees may not have to fall back on their individual insurance policies for most of their medical insurance needs, thus increasing the utilisation of GMC plans.
Employers can allow employees to cover their dependent family members. It can be done by including this benefit as a part of the policy or empowering employees to add their family members by paying an additional premium.
Employees can claim under the GMC and benefit from the No Claim Bonus from individual health insurance policies.
Also, GMC can be utilised for lower claims and individual covers can be utilised for higher claims.
In certain organisations, the claim process might involve a lot of paperwork and a cumbersome approval process. A similar problem can be on the insurer’s side as well.
In these cases, employees may feel that their sensitive, private information is being shared. However, if the claim process is digital and discreet, employees may not feel uncomfortable to register claims.
The following measures can be undertaken in this regard.
Partnering with an insurer that allows direct claim settlement via a mobile application. This way, employees can claim without paperwork and almost discreetly.
Reducing paperwork will certainly reduce the number of eyeballs the claim application needs to go through within the organisation. This will reduce admin hassles for the organisation as well.
The top management may take inputs from its workforce to increase the usage of GMC by:
conducting surveys to obtain feedback pertaining to the GMC.
conducting periodic reviews about the GMC with the employees.
Personalisation certainly blurs the lines between individual health insurance policies and group healthcare plans for the good. Typically, a GMC lacks this personal touch for employees. However, new-age insurance providers have changed that perception by offering flexibility.
For example, under ACKO Health, covered employees can benefit from the following personalisation features and services.
Employees can personalise their coverage with top-ups and riders.
Employees can track their fitness activities via the ACKO app.
Employees can opt for one-on-one virtual sessions with nutritionists, mental wellness coaches and doctors.
Employees can directly connect with pharmacies for medicines and laboratories for tests.
Digital-first insurers in the country have made considerable systemic advancements and equipped themselves to offer a value-based and affordable GMC.
The entire process of obtaining, servicing, and utilising group healthcare plans has become seamless, efficient, and quick.
Thus, it is the perfect time for organisations to partner with a digital-first insurer and progressively improve their group healthcare plans to achieve employee welfare goals.
This content piece is meant for informational purposes. It has been written from the data available in the public domain and based on industry experience. No part of the article should be considered as legal advice.
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